A fundamental requirement for success to achieve the new global health targets of the SDGs is agreement on the terminology used, as well as time-bound goals. Target 3.8. – Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all – seems problematic in this respect. Unlike other targets, there is no set date. Also, it seems the definition of Universal Health Coverage is still open to interpretation?

The concept of Universal Health Coverage has been promoted by WHO for over 10 years, and until recently the emphasis has been been on financial affordability rather than quality of healthcare services. Access to surgical care, for example, was not ‘officially’ included until May 2015, when the 68th World Health Assembly passed a resolution on 22nd May 2015 on ‘Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage’.

A recent Lancet Commission on Global Surgery reports findings from an international, multidisciplinary team of 25 commissioners, supported by advisors and collaborators in more than 110 countries and six continents.

‘5 billion people do not have access to safe, affordable surgical and anaesthesia care when needed. Access is worst in low-income and lower-middle-income countries, where nine of ten people cannot access basic surgical care…’

‘Universal health coverage and the health aspirations set out in the post-2015 Sustainable Development Goals will be impossible to achieve without ensuring that surgical and anaesthesia care is available, accessible, safe, timely, and affordable…’

‘Maintenance of a motivated workforce in low-resource environments is essential for service provision, and ministries of health and professional societies should take active steps to ensure these clinicians are celebrated instead of neglected. To ensure that providers have the necessary instruments to practise is imperative, as are opportunities for continuing education and professional development. These resources include access to the internet, online clinical management resources, textbooks, and research literature…’

Best wishes, Neil

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